Overbite Correction Research Articles

Quality of occlusal outcome in adult Class II patients treated with completely customized lingual appliances and Class II elastics compared to adult Class I patients.

The aim of this investigation was to evaluate whether Class II malocclusion in adult patients can be successfully corrected using a completely customized lingual appliance (CCLA) in combination with Class II elastics. In order to detect differences in the final treatment outcome, two groups were matched for age and gender. Treatment results of 40 adult orthodontic patients with a Class I malocclusion (Group 1) were compared to 40 adults with a Class II malocclusion (Group 2). All patients had completed treatment with a CCLA (WIN, DW Lingual Systems, Bad Essen, Germany) without known centric occlusion-centric relation discrepancies, issues of compliance, or overcorrection in the individual treatment plan which was defined by a target set-up. In order to compare the treatment results of the two groups, 7 measurements using the American Board of Orthodontics Model Grading System (ABO MGS) and linear measurements for anterior-posterior (AP) and vertical dimensions were assessed at the start of lingual treatment (T1), after debonding (T2B) and compared to the individual target set-up (T2A). A statistically significant AP correction was achieved in Group 2 which represented 95% of the planned amount. The planned overbite correction was fully achieved in the Class I and Class II group. In both groups, there was a statistically significant improvement in the ABO scores, with no significant difference between the two groups at T2. 100% of the patients in Group 2 and 92.5% in Group 1 would meet the ABO standards after CCLA treatment. The main limitation of this study is that only patients who were wearing the elastics as prescribed were retrospectively included. Therefore, the results of this study may have limited generalizability. Completely customized lingual appliances in combination with Class II elastics can correct a Class II malocclusion successfully in adult patients. The final treatment outcome can be of a similar high quality in Class I and Class II patients.

Stability of skeletal open bite correction in adult patients by molar intrusion: A meta analysis

To review and compile literature to check the post retention stability of skeletal open bite correction by molar intrusion. Articles were searched in Electronic database of English literature i.e. PubMed, Cochrane Library, Embase and google scholar. Titles and abstracts of potential articles with inclusion criteria were examined and included based on consensus agreement. Abstracts of articles having characteristics that were uncertain were examined, with full article retrieval if necessary. The reference list of the retrieved articles were also searched. On comparing the mean post treatment and post retention of overbite derived from their respected forest plot graphs, there was 32 percent relapse in the overbite correction. This study states that skeletal open bite patients treated with molar intrusion have 68 % stability, whereas the intruded molar have a 95% stability.

Does Invisalign Outperform Fixed Appliance in Treating Vertical Discrepancies?

Aligners became popular among adult patients for their superior aesthetics and comfort in comparison to conventional fixedappliances. It has undergone numerous enhancements over time, allowing it to address more complex malocclusions. Many researchers argued that managing vertical discrepancies is more challenging than addressing anteroposterior issues. This complexity arose from the mechanical requirements for treatment and the required mechanics to prevent relapse. Studies assessing the treatment outcome of anterior open bite closure using clear aligners have yielded conflicting results regarding the mechanisms of bite closure. Proposed mechanisms included extrusion of upper or lower incisors, lingual tipping of upper or lower incisors, intrusion of upper or lower molars, counterclockwise rotation of the mandible, or various combinations of these mechanisms. The research highlighted the biomechanical challenges associated with using aligners for the treatment of deep bites as mandibular incisor intrusion and leveling the curve of Spee remain among the least predictable movements. Given the widespread use of aligners, it is imperative to rigorously assess the effectiveness of clear aligners in achieving overbite correction to ensure they deliver the desired outcome. This review aimed to assess the performance of Invisalign in the management of vertical discrepancies. It sought to identify the dentoskeletal effects of clear aligners in addressing deep bite and anterior open bite cases, understand the mechanisms behind overbite correction, and provide a comprehensive overview of the existing research on this topic.

Deep overbite reduction in adolescent patients treated with Invisalign: A retrospective analysis

Data regarding the efficacy of deep overbite correction with clear aligner therapy in adolescent patients are lacking. This study aimed to investigate the efficacy of deep overbite reduction in adolescent patients treated with Invisalign (Align Technology, San Jose, Calif) aligners. This retrospective study investigated a sample of 102 patients aged 10-17 years from a large database. All patients had completed wear of a prescribed series of Invisalign aligners with planned overbite reduction on a nonextraction basis. The predicted, pretreatment, and posttreatment overbite measurement values were obtained from Align Technology's ClinCheck digital facility. Linear modeling, with Bland-Altman plots, was used to compare the effect of age, the use of bite ramps, and the adoption of the eighth-generational (G8) protocol on the difference between predicted and achieved overbite measurements. A total of 102 patients with a mean ± standard deviation age of 13.94 ± 1.53 years satisfied the selection criteria. A mean ± standard deviation of 41.38 ± 30.43% of the predicted overbite reduction was achieved. There were no differences in the predictability of overbite reduction between patients who were aged<14 years or those aged 14-17 years (P= 0.73), between patients prescribed and not prescribed bite ramps (P= 0.25), or between patients prescribed the G8 protocol and not prescribed the G8 protocol (P= 0.65). The average achieved overbite was less than half of what was planned by the orthodontists via the ClinCheck facility. The age grouping, the provision of bite ramps, and the G8 protocol appear to have little influence on the efficacy of overbite reduction in adolescent patients.

Evaluation of Mandibular Projection in Class II Division 2 Subjects Following Orthodontic Treatment Using Clear Aligners.

The purpose of this study was to evaluate the mandibular growth and/or projection following maxillary incisor proclination, overbite correction, and maxillary dentoalveolar expansion without the use of any class II mechanics, in growing class II division 2 patients treated with clear aligners. Before and after treatment cone-beam computed tomographic (CBCT) generated lateral and posteroanterior cephalograms of thirty-two patients with skeletal class II division 2, 16 in the treatment group and 16 in the untreated group, were reviewed to evaluate treatment-related changes. Upper incisors were proclined and protruded, as well as upper arch expansion and overbite correction were performed as part of their regular treatment. Cephalometric analysis was performed to evaluate skeletal and dental changes. Unpaired statistical t-tests were performed to determine if significant skeletal class II correction was achieved in the treatment group. In the treatment group, after treatment, the upper incisors became more proclined and protruded, and the inter-molar width increased while the overbite was reduced compared to the control group. An increase in skeletal mandibular growth and forward projection was also observed, thus contributing to an improvement of the sagittal skeletal relationship as evidenced by ANB and Wits values compared to the control group. A combination of upper incisor proclination, correction of deep overbite, and maxillary dentoalveolar expansion using clear aligners appears to contribute to an improvement of the skeletal class II relationship in growing patients with class II division 2. This study shows that unlocking the mandible by correcting a deep overbite, proclining upper incisors, and expanding the upper arch in growing class II division 2 patients can improve skeletal class II using clear aligners. How to cite this article: Mirzasoleiman P, El-Bialy T, Wiltshire WA, et al. Evaluation of Mandibular Projection in Class II Division 2 Subjects Following Orthodontic Treatment Using Clear Aligners. J Contemp Dent Pract 2024;25(4):295-302.

Two simple yet efficient biomechanics for correction of retroclined maxillary central incisors

Angle’s class II division 2 malocclusion is characterized by retroclined maxillary central incisors and increased overbite. The first step in the treatment of such cases involves the correction of incisor inclination and their intrusion. Conventional techniques for intrusion are taxing on the anchor teeth like molars and adjacent teeth like lateral incisors. Appropriate biomechanical use of temporary anchorage devices (TADS) will enable the clinician to avoid undesirable tooth movements. The following are two cases in which simple and efficient biomechanics have been performed with the use of TADS for the correction of incisor inclination and deep overbite. The case-specific use of single vs two mini implants as well as round vs rectangular wire for intrusion and proclination of central incisors has also been explained.

Influence of Invisalign precision bite ramp utilization on deep bite correction and root length in adults.

To assess the influence of Invisalign precision bite ramp use on skeletal deep overbite correction and root length and volume of maxillary anterior teeth. This was a retrospective study of 60 adults with skeletal deep overbite. Patients were divided into three groups: Invisalign (Align Technology, San Jose, Calif) with precision bite ramps (Invisalign with Bite Ramps [IBR] = 12), Invisalign with no bite ramps (INBR = 22), and full-fixed appliances (FFA = 26). Cone beam computed tomography records at T1 (pretreatment) and T2 (posttreatment) were used to measure eight skeletal, nine dental, and three soft-tissue cephalometric variables. Maxillary anterior teeth root length (mm), root volume (mm3), and percent root volume loss between T1 and T2 (%) were also recorded. Significant changes from T1 to T2 among the three groups were seen in ANB(o), lower face height (%), ODI (overbite depth indicator) (o), and U1-SN (o). Reduction in root length was significantly less (P < .001) in the INBR and IBR groups compared to the FFA group. Reduction in root volume and percent volume loss were significantly higher in the INBR group compared to the IBR group (P < .001), but the difference between the two Invisalign groups and the FFA group was not significant. Skeletal deep overbite correction using Invisalign with or without bite ramps is comparable to FFA. Reduction in root length was significantly less with Invisalign compared to FFA. Bite ramps influenced root volume and volume loss but not root length.

Quality of occlusal outcome in adult class II patients after maxillary total arch distalization with interradicular mini-screws

BackgroundThe aim of the investigation was to evaluate if a Class II malocclusion in adult patients can be successfully corrected by maxillary total arch distalization with interradicular mini-screws in combination with completely customized lingual appliances (CCLA).MethodsTwo patient groups were matched for age and gender to determine differences in the quality of final treatment outcome. The treatment results of 40 adult patients with a Class I malocclusion (Group 1) were compared with those of 40 adult patients with a moderate to severe Class II malocclusion (Group 2). All patients had completed treatment with a CCLA (WIN, DW Lingual Systems, Bad Essen, Germany) without overcorrection in the individual treatment plan defined by a target set-up. To compare the treatment results of the two groups, 7 measurements using the American Board of Orthodontics Model Grading System (ABO MGS) and linear measurements for anterior-posterior (AP) and vertical dimensions were assessed at the start of lingual treatment (T1), after debonding (T2B), and compared to the individual target set-up (T2A).ResultsA statistically significant AP correction (mean 4.5 mm, min/max 2.1/8.6, SD 1.09) was achieved in Group 2, representing 99% of the planned amount. The planned overbite correction was fully achieved in both the Class I and Class II groups. There was a statistically significant improvement in the ABO scores in both groups (Group 1: 39.4 to 17.7, Group 2: 55.8 to 17.1), with no significant difference between the two groups at T2B. 95% of the adult patients in Group 1 and 95% in Group 2 would meet the ABO standards after maxillary total arch distalization with a CCLA and interradicular mini-screws.ConclusionsCCLAs in combination with interradicular mini-screws for maxillary total arch distalization can successfully correct moderate to severe Class II malocclusions in adult patients. The quality of the final occlusal outcome is high and the amount of the sagittal correction can be predicted by the individual target set-up.

Does aligner refinement have the same efficiency in deep bite correction?: A retrospective study

BackgroundRefinements are very common in clear aligner treatments. The aim of this study is to assess whether the predictability of deep overbite correction is similar over several refinements using clear aligners (Invisalign, Align Technology, San Jose, Calif) and examine the accuracy of vertical movement and inclination change of individual teeth.MethodsThis retrospective study included 20 deep bite patients (7M and 13F; 32.63 ± 11.88 years old; an initial overbite of 5.09 ± 0.98 mm), consecutively treated from September 2016 and March 2023, who completed at least two sets of aligners, including refinements. The initial, predicted, and achieved models were exported from ClinCheck or OrthoCAD (Cadent Inc, Carlstadt, NJ) and superimposed via best-fit surface-based registration using SlicerCMF (version 4.9.0; cmf.slicer.org). We also examined 15 out of 20 patients who completed treatments. The overbite correction and changes in vertical movement and inclination for individual teeth were measured. Descriptive statistics and a paired t-test or Wilcoxon signed-rank test were performed. P < 0.05 was considered statistically significant.ResultsThe mean accuracy of overbite correction was 37.63% after 1st set, followed by 11.19%, 6.32%, and 13.80% (2nd-4th sets), respectively. There were statistically significant differences between the predicted and achieved vertical movements and inclination changes for all teeth for the 1st and 2nd sets. For the completed cases, the mean overbite correction was 38.54% compared to the initially planned overbite correction, which is similar to one of the 1st set. Still, the vertical movements and inclination changes of all teeth present statistically significant differences between the initially planned and finally achieved movements except for maxillary lateral incisor torque.ConclusionsThe most overbite correction occurs during the 1st set of aligners, and refinement treatment does not significantly improve the deep bite correction.

Short- and Long-Term Effects of Maxillary Expander with Tongue Crib in Growing Open-Bite and Skeletal Class II Patients: A Retrospective Study.

The purpose of this study was to evaluate short- and long-term changes in growing patients with Class II malocclusion and open bite after rapid maxillary expansion (RME). A retrospective cohort study was conducted with 16 growing patients with open-bite malocclusion enrolled in a group treated with a rapid maxillary expander (RME) with a crib (TG), and 16 untreated patients with similar malocclusion in the control group (CG). Cephalograms were recorded before starting the treatment (T0), at the end of the latency phase (T1), and before the fixed therapy (T2) in order to analyze skeletal and dental changes in vertical, transversal, and sagittal relationships. Statistical analysis was performed with α = 0.05 as level of significance. At the end of the active expansion (T1), all subjects in the TG showed a corrected overbite with a statistically significant difference compared to the CG (p > 0.05). A significant decrease in jaw divergence was found in the TG compared to the CG (p < 0.05). At T2, all treated patients maintained a correct overbite. Statistical analysis revealed a significant decrease in maxillary, mandibular, and intermaxillary divergence in the TG compared to the CG (p < 0.05). This protocol could be effective in growing open-bite patients, showing a long-term decrease in facial divergence. The fixed crib allowed to normalize myofunctional activity.

Demonstration of the effectiveness of the bionator as a functional appliance used for the treatment of class II malocclusion

Angle class II malocclusion is a condition in which the upper teeth are positioned in front of the lower teeth, usually due to abnormal growth of the lower jaw in relation to the upper jaw, or due to a receding of the lower teeth. . The use of Bionator is one of the many orthopedic devices that are used today for the correction of class II, division I, presents alterations in the jaw, teeth and muscles. This research aims to highlight the effectiveness of the bionator as a functional device widely used for the treatment of class II malocclusion, through the presentation of a clinical case. A minimal control experimental study was carried out to determine the possible morphological changes in a patient with Angle Class II division 1 with the use of the Bionator, in a period of 12 months. An observational, descriptive and retrospective study was carried out. The use of the Bionator proved to be a favorable alternative for the correction of the patient's overbite and profile. Success is directly related to the patient's collaboration, not requiring correction with fixed appliances in this case. There was an improvement in the patient's facial profile and a pleasant aesthetic smile at the end of the treatment. Based on this result, the use of functional orthopedic devices is recommended in the treatment of class II division 1 malocclusions based on an adequate diagnosis, correct selection of the orthopedic device and excellent patient collaboration

Does age influence deep overbite correction with Invisalign? A prospective study evaluating mandibular incisor intrusion in adolescents vs adults.

To compare the accuracy of mandibular incisor intrusion with Invisalign (Align Technology, Santa Clara, Calif) in adolescents to that in adults. This prospective clinical study included 58 patients treated with either Invisalign Teen or Invisalign Full. Mandibular central and lateral incisors were measured on digital models created from intraoral scans. Predicted values were determined by superimposing the initial and final ClinCheck models, and achieved values were determined by superimposing the initial ClinCheck models and the digital models from the final scans. Individual teeth were superimposed with a best-fit analysis and measured using Compare software (version 8.1; GeoDigm, Falcon Heights, Minn). The mean accuracies of mandibular incisor intrusion were 63.5% in adolescents and 45.3% in adults, and this difference was statistically significant. The amounts of achieved intrusion were 1.7 mm in adolescents and 0.9 mm in adults, and this difference was also statistically significant. Overall, there was a weak negative correlation between age and accuracy; as age advanced, the accuracy of mandibular incisor intrusion diminished slightly. Mandibular incisor intrusion with Invisalign is significantly more accurate in adolescents than in adults. Orthodontists could contemplate reducing the degree of overcorrection for mandibular incisor intrusion in adolescents with deep overbites undergoing Invisalign Teen but still implementing the reverse curve of Spee mechanics.

Predicted and achieved overjet and overbite measurements with the Invisalign appliance: a retrospective study.

To determine whether achieved outcome regarding overjet and overbite matched the predicted outcome following treatment with Invisalign (Align Technology, San Jose, Calif) aligner appliances. Data including pretreatment, predicted and achieved overjet, and overbite measurements provided by Align's digital treatment facility, ClinCheck Pro, were evaluated. Descriptive statistics, Mann-Whitney U-test, and Wilcoxon rank-sum intraclass correlation (ICC) test results were calculated. From an initial sample of 600, 355 adult patients satisfied the inclusion and exclusion criteria. ICC scores for data input were excellent. Median (interquartile range [IQR]) age was 30.14 (23.33, 39.92) years and most (n = 259; 72.95%) were women. Almost one-third (n = 101; 28.45%) had undergone extraction as part of their treatment. More aligners were prescribed in the initial digital treatment plan for patients (median, 44; IQR: 35, 51.5; minimum, 17; maximum, 92) undergoing extractions as part of their orthodontic treatment than those who were not (median, 24; IQR: 18.25, 32; minimum, 13; maximum, 85) (P < .0001). Planned changes in overjet differed significantly from achieved outcomes (P < .001). Planned increases in overbite resulted in up to more than twice (222.72%) as much increase than predicted. Planned reduction of overbite achieved 8.69% of its predicted reduction in extraction cases. Achieved overjet and overbite measurements differed significantly from the predicted outcomes at the end of an initial sequence of aligners. Planned increases in overbite resulted in greater overbite correction than predicted, particularly in extraction cases. Planned overbite reduction was challenging, especially in patients with extractions.

Evaluation of True Incisor Intrusion Achieved with Single Mini Implant for Correction of Deep Overbite in Adult Patients

Evaluation of True Incisor Intrusion Achieved with Single Mini Implant for Correction of Deep Overbite in Adult Patients

Clear aligners for Class III malocclusion and severe open bite camouflage: A case report

Objective: The aim of the study was to describe a clinical case of a Class III malocclusion and severe open bite approached with clear aligners (CAs) and intermaxillary elastics. Case Presentation: A 21-year-old male patient showed to the dental clinic asking for orthodontic treatment. His chief complaint was an unpleasant smile esthetics. The patient showed an oval face with increased length of the lower third of the face, slight mandibular asymmetry, and concave profile. On intraoral evaluation, a bilateral canine and molar Class III with reduced overbite could be seen. Pre-treatment panoramic radiograph showed good root parallelism and presence of all dental elements. Cephalometric values confirmed skeletal Class III (Wits Appraisal = −6.5 mm), increased vertical dimension (FMA = 34.3°), correctly inclined upper incisors and retroclined lower incisors. After discussing the treatment options with the patient, CAs (F22, Sweden and Martina, Due Carrare, Padova, Italy) were chosen to approach this malocclusion together with intermaxillary elastics. After 9 months of active treatment involving 18 sets of aligners, the patient showed correct overbite, bilateral canine e molar Class I, leveled and aligned dental arches, and no signs of radicular or bone resorption. Cephalometric parameters show control of vertical dimension (FMA = 34.4°), upper incisor flaring and lower incisor retroclination, and signs of a dentoalveolar compensation. Conclusion: Careful diagnosis, treatment planning, and clinical management of CAs and intermaxillary elastics led to a successful dentoalveolar compensation featured by good occlusal results, bilateral Class I relationship, and normal overbite which remained stable after 1 year from the end of treatment.

Class II Division 1 Malocclusion Treated with Two-Phase Orthodontic Approach

Enhancing facial aesthetics is a primary motivation for individuals with class II division 1 malocclusion seeking orthodontic treatment. Among the different techniques available to treat Class II malocclusions, a two-phase approach involving functional jaw orthopedics and fixed orthodontic treatment is commonly employed. In this case report, we present the treatment of a young male patient with a Class II Division 1 malocclusion. In the initial phase, the patient underwent growth modification and correction of overjet, overbite, and profile using the Andresen activator. Subsequently, a fixed orthodontic appliance was utilized in the second phase to achieve well-aligned arches and enhance both aesthetics and functionality.

Two-stage treatment of skeletal Class II malocclusion: case report

Objective: class II malocclusion is one of the most frequent problems in orthodontics and is characterized by maxillary prognathism, mandibular retrognathism, or both. The aim of this study is to report the case of a patient with Angle Class I and Skeletal Class II malocclusion in the growth phase treated in two phases with AEB and orthodontic mini-implant. Case report: female patient, 9 years old, reported an accentuated projection of the anterior teeth. She had the habit of interposing the lower lip, dolichofacial pattern, Angle Class I molars, and great projection of the upper incisors. In the first phase was used AEB, and in the second phase an interradicular mini screw with sliding jig to finalize Class II correction on the left side. Conclusion: it’s evident the benefits of first orthopedic/functional phase in overbite correction and success of the proposed treatment through the stability after 4 years of case management.

Early treatment for anterior open bite: Choosing adequate treatment approaches

Anterior open bite is considered one of the most challenging malocclusions to correct, especially regarding stability. There are numerous publications on the subject but with controversial information. Disagreements occur in most aspects of this malocclusion, such as the definition of an open bite, its etiological factors, treatment timing, and ideal treatment alternatives. The lack of consensus on the etiology of anterior open bite has led to different treatment approaches, which may explain the high rate of post-treatment instability. Furthermore, the etiological factors of this malocclusion typically result in myofunctional imbalance, which alters the harmony of muscular forces responsible for maintaining an adequate occlusion. Nevertheless, the literature indicates a scarcity of scientific evidence that myofunctional therapy helps to correct open bites. In addition, there is evidence that eliminating deleterious habits allows spontaneous overbite correction and brings physiological and psychological benefits to the child. Considering the possibility of a spontaneous reduction of this malocclusion with age, it is understood that not every child needs early treatment. To avoid overtreatment, the choice for intervention should assess possible causes and severity, the patient's age, and parental concerns. Therefore, this paper discusses possible early treatment approaches for anterior open bite.

Quantifying the efficacy of overbite reduction in patients treated with clear aligners using optimized versus conventional attachments.

Deep overbite has been shown to be difficult to correct with clear aligners. Optimized deep bite attachments are reported to facilitate deep bite correction with aligners. The aim of this retrospective study was to quantify the efficacy of deep bite correction with aligners when using optimized versus conventional attachments. This was a retrospective cohort study. The pretreatment and post-treatment intraoral scans of patients with deep overbite treated with Invisalign clear aligners were accessed. Patients were divided into two groups: group A, patients treated with conventional attachments, and group B, patients treated with optimized attachments. Pre and post-treatment overbite and the planned overbite reduction were measured and compared between groups. Descriptive statistics were computed, and statistical significance was set at P<0.05. Seventy-eight patients were included. There was no statistically significant difference in overbite reduction between patients who had conventional versus optimized attachments. The amount of overbite reduction observed post-treatment was found to be no more than 33-40% of the planned amount of overbite reduction across all patients and groups. Deep overbite correction with aligners remains difficult regardless of the type of attachment used. Optimized attachments are no more effective than using conventional attachments in reducing deep overbite. The amount of overbite reduction expected with clear aligners is significantly lower than the planned overbite reduction. When correcting deep bite with clear aligners, the attachment type does not improve the success rate. Clinicians should plan to overcorrect deep bite reduction to expect only 33% to 40% of their planned final overbite to be actually expressed.

The efficacy of anterior open bite closure when using Invisalign's optimized extrusion versus conventional attachments.

Clear aligners are reported to control anterior open bites. Despite this, anterior extrusion remains difficult with aligners. Optimized extrusion attachments on incisors may facilitate anterior extrusion to correct open bite with Invisalign. The aim of this retrospective study was to compare the efficacy of anterior open bite correction with Invisalign when using optimized extrusion versus conventional attachments. This was a retrospective cohort study. The pre- and post-treatment intraoral scans of patients with anterior open bite treated with Invisalign aligners were assessed. Patients were divided into two groups: group A, patients with horizontal conventional attachments and group B, patients with optimized extrusion attachments on incisors. The pre and post-treatment overbite and the planned overbite change were measured and compared between the groups. Descriptive statistics were computed and statistical significance was set at P < 0.05. A total of 86 patients were included. Both groups showed significant increases in overbite, but there was no difference in the open bite correction efficacy in patients with conventional versus optimized attachments. Shorter treatment times for open bite closure were reported for patients with optimized attachments. Anterior open bite can be corrected regardless of the attachment type. Optimized attachments are no more effective than using conventional attachments in incisor extrusion to correct open bite. Patients with anterior open bite with optimized attachments observed shorter treatment times for overbite correction. When correcting anterior open bite with Invisalign, the attachment type does not improve the success rate. Optimized extrusion attachments on incisors may shorten the treatment time compared to conventional attachments.